PDF
(Download)
|
- Lemon Verbena (Aloysia citriodora)
- Fish Oil
- Arthritis
| Date:
03-15-2012 | HC# 011264-444
|
Re: Joint Status Improved by Lemon Verbena Extract Combined with Fish Oil
Caturla N,
Funes L, Pérez-Fons L, Micol V. A randomized, double-blinded,
placebo-controlled study of the effect of a combination of lemon verbena
extract and fish oil omega-3 fatty acid on joint management. J Altern Complement Med. November 2011;17(11):1051-1063.
Arthritis is
characterized by inflammation of the joints, and there are 2 general types of
the disease. Osteoarthritis (OA) is associated with age-related joint
degeneration, while rheumatoid arthritis (RA) is caused by autoimmune joint
inflammation. Cartilage destruction, synovial fluid disruption, mitochondrial
dysfunction, and other joint-related problems have been found to be caused by
reactive oxygen and nitrogen species (RONS). Many plants used medicinally have
antioxidant activity, and many plant antioxidant compounds alleviate diseases
caused by inflammation.
Lemon
verbena (Aloysia citriodora syn. A. triphylla and Lippia citriodora), used traditionally for a variety of ailments,
contains the potent antioxidant and anti-inflammatory phenylpropanoid compound
verbascoside. In addition, the long chain omega-3 polyunsaturated fatty acids
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), found in cold-water
fish oil, have been shown to affect the immune system. This double-blind,
placebo-controlled, randomized study investigated the effects of a mixture of
lemon verbena extract and fish oil omega-3 fatty acids on patients with joint
pain and dysfunction. In addition, the antioxidant capacity of both the extract
and treatment mixture was assessed in vitro.
The lemon
verbena extract was dissolved with water (5 mg/ml), and the verbascoside
content of the extract was analyzed using high-performance liquid
chromatography (HPLC). Antioxidant activity was measured using the oxygen
radical absorbance capacity (ORAC) assay and data expressed as µmole of Trolox equivalents
(TE) per gram; in this particular assay, a higher ORAC value indicates stronger
antioxidant activity.
Included
patients were diagnosed by a physician as having joint discomfort and pain in
knees, hips, elbows, hands, or shoulders for 3 months or more. Patients were
excluded if they used medication other than for high cholesterol, or antihypertonic
or antiarrhythmic agents. Patients were also excluded if they had plant, herbal
medicine, vitamin, or mineral allergies. Patients were randomized to either
supplement (n=23) or placebo (n=22) groups for the 9-week study. A capsule of the
supplement (0.6 g) consisted of 370 mg of fish oil powder containing a ratio of
10:8 EPA to DHA, and 230 mg of lemon verbena extract containing 14% w/w
verbascoside. All patients took 6 capsules daily of placebo or supplement, 2
before each meal from week 1 to week 5. At the beginning of week 6, patients
took 3 capsules per day before meals until week 9. The dose per day of
verbascoside from weeks 1-5 was 193 mg, and 97 mg for weeks 6-9.
The primary
endpoints were joint pain, stiffness, and function. These were assessed using
the Western Ontario McMaster (WOMAC) and Lequesne's surveys. The WOMAC
questionnaire is designed to measure pain/stiffness and physical dysfunction,
while Lequesne's assesses pain, discomfort, maximum distance walked, and daily
activities. Reduced severity of these arthritis factors is indicated in a low
score for both questionnaires. Surveys were completed by patients at baseline
and at least once per week during the study.
It was found
that verbascoside was the most common phenylpropanoid in the lemon verbena
extract and occurred at 14.75 ± 0.85% w/w. Isolated verbascoside had an ORAC
value of 11,710 ± 106 µmol TE/g, while the extract was 5,183 ± 300 µmol TE/g.
The total supplement was found to have antioxidant activity of 1,065 ± 122 µmol
TE/g. It is surmised that excipients associated with the omega-3 fatty acids
may have interfered in the assay, resulting in a value lower than expected. Of the
45 total patients randomized, 31 completed the study (n=12 for the placebo
group and n=19 in the supplement group). No significant differences were seen
between groups at baseline, and the majority of patients maintained normal
physical activity. Only 1 adverse side effect was found in each group; these patients
were dropped from the study, supplementation discontinued, and no complications
ensued.
The WOMAC
scores in the supplement group declined steadily throughout the study, and the
pain/stiffness and function scores of the test first significantly differed
from the placebo group at weeks 3 (P≤0.01) and 4 (P≤0.05), respectively. Also,
the total WOMAC score of the supplement group at 9 weeks was 53% lower than the
baseline score. No significant changes were observed in the WOMAC score of the
placebo group. In addition, the Lequesne's score of the supplement group was
significantly different from the placebo group at week 4 (P≤0.05) and remained
significant from weeks 5-9 (P≤0.01). By the end, the score had decreased by 78%
as compared to the baseline score. No significant differences were seen in the Lequesne's
scores of the placebo group.
The
combination supplement of lemon verbena extract and omega-3 fatty acids
significantly improved arthritis symptoms in this study. Many previous studies
have shown that a diet rich in antioxidants may improve disorders caused by exercise-induced
free radicals and other RONS-caused inflammation problems. Lemon verbena
extract and compounds therein demonstrate antioxidant activity, and omega-3
fatty acids have been shown to benefit those suffering from joint problems;
therefore, this tested mixture is worthy of future investigation into the
treatment of arthritis and other inflammation diseases.
—Amy C. Keller,
PhD
|